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Right versus left parasternal electrode position in the entirely subcutaneous ICD

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Abstract

Objectives

The subcutaneous implantable cardioverter defibrillator (S-ICD®) has been established as an alternative to conventional transvenous ICD for the prevention of sudden cardiac death. Initial studies have shown safety and efficacy of the system with a left parasternal (LP) electrode. However, several case studies reported a right parasternal (RP) position. The purpose of this study was to analyze shock efficacy and safety of an RP electrode position.

Methods

Between June 2010 and May 2016, 120 S-ICD® were implanted at our institution. On the basis of the heart location on preoperative chest radiography (CXR), the investigators decided on an RP (n = 52) or LP electrode position (n = 68). All perioperative induced VF episodes, and spontaneous appropriate and inappropriate episodes during follow-up were analyzed.

Results

Patients with an RP electrode did not differ in terms of age, sex, or ejection fraction. A statistically significant difference in underlying cardiac disease was observed between the RP and LP electrode group, with more patients with channelopathies in the RP electrode group and more patients with non-ischemic cardiomyopathy in the LP electrode group. During a mean follow-up of 24.3 ± 19.5 months, 27 appropriate (19 in the LP group and 8 in the RP group) and 28 inappropriate (18 LP and 10 RP) ICD shocks occurred (p value = NS).

Conclusions

In the present study, an RP electrode position was chosen on the basis of chest radiographic characteristics and was efficient in terms of sensing and shock efficacy. Thus, a right-sided electrode implant might be an alternative if a left-sided electrode implant is inadequate. It might also be favorable for young patients with narrow heart silhouettes in the midsagittal position.

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Abbreviations

ACHD:

Adult congenital heart disease

ATP:

Antitachycardic pacing

CAD:

Coronary artery disease

DCM:

Dilative cardiomyopathy

ICD:

Implantable cardioverter defibrillator

HCM:

Hypertrophic cardiomyopathy

SCD:

Sudden cardiac death

S-ICD® :

Subcutaneous implantable cardioverter defibrillator

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Authors and Affiliations

  1. Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Markus Bettin, Dirk Dechering, Gerrit Frommeyer, Robert Larbig, Florian Reinke, Julia Köbe & Lars Eckardt

  2. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany

    Andreas Löher

Authors
  1. Markus Bettin
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  2. Dirk Dechering
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  3. Gerrit Frommeyer
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  4. Robert Larbig
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  5. Andreas Löher
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  6. Florian Reinke
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  7. Julia Köbe
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  8. Lars Eckardt
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Corresponding author

Correspondence to Markus Bettin.

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Conflict of interest

MB, DD, GF, FR, JK, and LE have received travel grants and lecture honoraria from BIOTRONIK, Boston Scientific, Medtronic, Sorin Group, and St. Jude Medical.

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Bettin, M., Dechering, D., Frommeyer, G. et al. Right versus left parasternal electrode position in the entirely subcutaneous ICD. Clin Res Cardiol 107, 389–394 (2018). https://doi.org/10.1007/s00392-017-1194-y

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  • DOI: https://doi.org/10.1007/s00392-017-1194-y

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